The short answer is yes – we’re on track to do just that. While cervical cancer is the fourth most common cancer among women worldwide, Australia is already leading the way towards eliminating the disease on a global scale, with promising results showing how it can be done
“Australia is a global leader in cervical cancer prevention programs, technology and research,” says Professor Marion Saville AM, Executive Director of VCS Foundation. “We have one of the lowest cervical cancer incidence and mortality rates in the world.”
So how have we done it?
In the 1980s, German researchers showed that most cases of cervical cancer were caused by a common virus called the Human Papillomavirus, or HPV. The other main risk factor for cervical cancer is smoking, while there is a small risk associated with long term use of the contraceptive pill or for people who have a weakened immune system, particularly if you are living with HIV and not receiving adequate treatment.
The cancer itself is the growth of abnormal cells in the lining of the cervix. The most common cervical cancer is squamous cell carcinoma, accounting for around 70% of cases. Less common is adenocarcinoma, which is harder to diagnose because it’s starts higher in the cervix.
However, any cervical cancer is a preventable disease and curable if detected early.
So we began screening. In 1991 the National Cervical Screening Program was launched across Australia and using a regular Pap smear test to detect abnormal cells, resulted in a 50% drop in cervical cancer incidence and mortality over the first decade of the program.
Australia’s Professor Ian Frazer was instrumental in the development the Human Papillomavirus vaccine Gardasil which has resulted in significant decreases in the incidence of cervical pre-cancers in countries where it is widely available and is beginning to result in decreases in invasive cervical cancers.
In December 2017, Australia then became one of the first countries to introduce HPV-based cervical screening.
“Australia changed its screening program from Pap smears as the primary test, every two years to a test that detects HPV every five years because we know that the HPV test is more sensitive, allowing us to test less often, but also to deliver lower cancer rates,” says Prof Saville.
Research by Adjunct Professor Karen Canfell at Cancer Council NSW found that as many as 74 million cases could be averted and 62 million lives could be saved globally, if 78 of the poorest countries in the world are able to rapidly scale up HPV vaccination, cervical screening and access to cancer treatment services.
“You're much more likely to develop cervical cancer if you live in a lower- or middle-income country or indeed in Australia, if you don't have access to good quality screening programs historically,” says Prof Saville. “We also know there's an important gap in cancer rates in Australia that is critical to address. Aboriginal women and Torres Strait Islander women are twice as likely to develop cervical cancer than other women and three times more likely to die from it if they are diagnosed.”
“It is imperative that we offer our support to less well-resourced countries to scale up HPV vaccination and cervical screening,” she continues. “Solutions must be locally driven to ensure they are acceptable to and suitable for local populations and health systems. Australia can offer assistance by providing technological expertise and sharing knowledge.”
That assistance is happening already. VCS is providing Australian expertise in cervical screening and HPV testing to the global health community, particularly to countries in our region including Malaysia, Papua New Guinea, Fiji and Samoa.
“Cervical cancer is one of the most preventable and curable cancers if diagnosed early and managed effectively. Tragically for many women in low income countries access to early diagnosis and treatment is limited,” acknowledges Associate Professor Helen Evans AO from the Pacific Friends of Global Health. “However, the HPV vaccine is a highly effective prevention measure with the potential to reduce cervical cancer globally by as much as 90%.”
“We want to achieve elimination globally by the end of the century,” says Prof Saville, “and in order to be on track to do that, the WHO strategy is that by 2030 all countries should have vaccinated 90% of girls by the age of 15, that 70% of women should have at least two screening tests in their lifetime, and 90% of the women identified with the disease receive treatment.”
“Obviously some countries, like Australia are already very close, which means we'll achieve elimination sooner. In fact, there is a publication from my colleague Professor Karen Canfell predicting Australia could reach the elimination targets by 2030.”
And that is something we can all look forward to.
